Doctors Advise Caution as Energy Drinks May Trigger Life-Threatening Cardiac Arrhythmias in Patients with Genetic Heart Diseases

A new study opens in new tab/window in Heart Rhythm opens in new tab/window, the official journal of the Heart Rhythm Society, the Cardiac Electrophysiology Society, and the Pediatric & Congenital Electrophysiology Society, published by Elsevier, examined the potential dangers of consuming energy drinks for patients with genetic heart diseases. A cohort of 144 sudden cardiac arrest survivors was examined at Mayo Clinic, of which seven patients (5%) had consumed one or more energy drinks in close proximity to their cardiac event. While the study did not prove direct causation, caution is advised, and doctors recommend that patients consume energy drinks in moderation.

Lead investigator of the study Michael J. Ackerman, MD, PhD, Genetic Cardiologist at Mayo Clinic and Director of the Mayo Clinic Windland Smith Rice Sudden Death Genomics Laboratory in Rochester, MN, says, "The energy drink market in the United States has been growing consistently over the past few years, raising concerns about the potential combined effects of caffeine consumption and additional unregulated ingredients in these beverages. Energy drinks are not regulated by the US Food and Drug Administration (FDA), so researching the effects that these drinks have on our patients is of utmost importance."

Energy drinks contain caffeine ranging from 80 mg to 300 mg per serving, compared with 100 mg in an 8-ounce cup of brewed coffee. However, most of these energy drinks contain other stimulating ingredients in addition to caffeine that are unregulated by the FDA, such as taurine and guarana. It has been postulated that the highly stimulating and unregulated ingredients alter heart rate, blood pressure, cardiac contractility, and cardiac repolarization in a potentially pro-arrhythmic manner.

Ehud Chorin, MD, PhD, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, co-author of the accompanying editorial commentary "Arrhythmogenic Foods – An Underestimated Medical Problem? opens in new tab/window" says, "Establishing a probable cause of an arrhythmia includes inquiring about a potential exposure to toxins or medications. An increasing number of substances in the standard diet are found to have unwanted cardiac effects, prompting the consideration of a novel subcategory in a patient’s clinical history intake: arrhythmogenic foods. Energy drinks fall in this category. The findings reported in this study should be viewed in the context of the large body of evidence suggesting arrhythmogenic effects of certain foods, especially when consumed in large quantities or large concentration by high-risk patients."

In addition to examining the consumption of energy drinks among the cohort of sudden cardiac arrest survivors, the researchers also looked closely at the type of cardiac event as well as the conditions surrounding the event, such as exercise and other stressors known to be associated with genetic heart disease-associated cardiac arrhythmias.

Dr. Ackerman explains, "While there seemed to be a temporal relationship between energy drink consumption and the seven patients' sudden cardiac arrest event, a myriad of potential 'agitators' that could have also contributed to a genetic heart disease-associated arrhythmia occurred, like sleep deprivation, dehydration, dieting or extreme fasting, concomitant use of QT-prolonging drugs, or the postpartum period. As such, unusual consumption of energy drinks most likely combined with other variables to create a 'perfect storm' of risk factors, leading to sudden cardiac arrest in these patients."

Peter J. Schwartz, MD, FHRS, Istituto Auxologico Italiano IRCCS, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, co-author of the accompanying editorial commentary "Energy Drinks and Sudden Death: If it Swims Like a Duck … opens in new tab/window", says, "Critics might say of these findings, ’it’s just an association by chance.’ We, as well as the Mayo Clinic group, are perfectly aware that there is no clear and definitive evidence that energy drinks indeed cause life-threatening arrhythmias and that more data are necessary, but we would be remiss if we were not sounding the alarm. At one point, clinical experience, solid understanding of pathophysiology, and common sense should join and speak up."

Dr. Ackerman concludes, “Although the relative risk is small and the absolute risk of sudden death after consuming an energy drink is even smaller, patients with a known sudden death predisposing genetic heart disease should weigh the risks and benefits of consuming such drinks in the balance.”

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Notes for editors

The article is “Sudden Cardiac Arrest Occurring in Temporal Proximity to Consumption of Energy Drinks,” by Katherine A. Martinez, BS, Sahej Bains, BS, Raquel Neves, MD, John R. Giudicessi, MD, PhD, J. Martijn Bos, MD, PhD, and Michael J. Ackerman, MD, PhD (https://doi.org/10.1016/j.hrthm.2024.02.018 opens in new tab/window). The article is openly available for 30 days at https://www.heartrhythmjournal.com/article/S1547-5271(24)00189-9/fulltext opens in new tab/window.

Journalists wishing to interview the authors should contact Terri Malloy, Mayo Clinic Communications, at [email protected] opens in new tab/window.

This work was supported by the Mayo Clinic Windland Smith Rice Comprehensive Sudden Cardiac Death Program (MJA) and the Mayo Clinic Center for Translational Science Activities (CTSA) through grant number UL1TR002377 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH).

The editorial commentaries are:

"Arrhythmogenic Foods – An Underestimated Medical Problem?" by Ido Avivi, MD, and Ehud Chorin, MD, PhD (https://doi.org/10.1016/j.hrthm.2024.03.020 opens in new tab/window). It is openly available for 30 days at https://www.heartrhythmjournal.com/article/S1547-5271(24)00265-0/fulltext opens in new tab/window.

“Energy Drinks and Sudden Death: If it Swims Like a Duck …,” by Peter J. Schwartz, MD, FHRS, Fulvio L.F. Giovenzana, MD, and Federica Dagradi, MD (https://doi.org/10.1016/j.hrthm.2024.02.043 opens in new tab/window). It is openly available for 30 days at https://www.heartrhythmjournal.com/article/S1547-5271(24)00215-7/fulltext opens in new tab/window.

Journalists wishing to interview the authors should contact Peter J. Schwartz at [email protected] opens in new tab/window, or Dr. Pierangelo Garzia, Head of Communications, IRCCS Istituto Auxologico Italiano, at [email protected] opens in new tab/window.

The articles appear online in advance of Heart Rhythm, volume 21, Issue 7 (July 2024) published by Elsevier.

Full text of the articles is also available to credentialed journalists upon request; contact Jane Grochowski at +1 406 542 8397 or [email protected] opens in new tab/window.

About Heart Rhythm

Heart Rhythm opens in new tab/window, the official Journal of the Heart Rhythm Society opens in new tab/window, the Cardiac Electrophysiology Society opens in new tab/window, and the Pediatric & Congenital Electrophysiology Society opens in new tab/window, is a unique journal for fundamental discovery and clinical applicability. It integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. www.heartrhythmjournal.com opens in new tab/window

About the Heart Rhythm Society

The Heart Rhythm Society opens in new tab/window is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal healthcare policies and standards. The Heart Rhythm Society is the preeminent professional group representing more than 8,000 specialists in cardiac pacing and electrophysiology from more than 94 countries. www.HRSonline.org opens in new tab/window

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